ADDICTION Flashcards
What is addiction
A disorder in which an individual takes a substance or engages in a behaviour that is pleasurable but eventually becomes compulsive with harmful consequences.
What 3 things is addiction marked by
Physiological and/or psychological dependence, tolerance and withdrawal
What is physical dependence
A state of the body due to habitual substance abuse which results in a withdrawal syndrome when use of the drug is reduced or stopped.
What is psychological dependence
A compulsion to continue taking a substance (or continue performing a behaviour) because its use is rewarding.
What is a consequence of psychological dependence
The person will keep taking the substance or engaging in a behaviour until it becomes a habit despite the harmful consequences
What is tolerance
A reduction in response to a substance, so that an addicted individual needs more to get the same effect.
What causes tolerance
Repeated exposure to the effects of a substance
What is behavioural tolerance
Give an example
It happens when an individual learns through experience to adjust their behaviour to compensate for the effects of a substance.
An alcoholic learns to walk slower so they dont fall when drunk.
What is cross-tolerance
Give an example
Developing a tolerance to one type of substance can reduce sensitivity to another type.
Alcohol and benzodiazepines
What is a risk factor
Any internal or external influence that increases the likelihood a person will start using addictive substances or engaging in addictive behaviours
Name the 5 risk factors for addiction
- Genetic vulnerability
- Stress
- Personality
- Family influences
- Peers
Explain how genetic vulnerability is a risk factor for addiction
People don inherit an addiction itself but a predisposition (vulnerability) to dependence.
Genes may determine the activity of neurotransmitter systems in the brain, which affect behaviours such as impulsivity which predispose a person to dependence.
Explain how stress is a risk factor for addiction
Does the stress have to be going on now
People who experience stress may turn to drugs as a form of self-medication
Stress includes present and past events
Explain how personality is a risk factor for addiction
Is there such thing as an ‘addictive personality’
Individual personality traits such as hostility and neuroticism may increase the risk of addiction.
Probably not.
Explain how family influences is a risk factor for addiction
Living in a family which uses addictive substances and/or has positive attitudes about addictions increases a person’s likelihood of becoming addicted
Explain how peers is a risk factor for addiction
As children get older, peer relationships become more important, even more than family.
Even if you dont use the drug your attitude towards them may be influenced
What is one limitation to risk factors
By focusing on one individual risk factor you may ignore the effect of interactions and also the positive effects.
Does one risk facto cause addictions
No
Combinations of risk matter more than single factors.
Who researched combinations of risk factors
Linda Mayes and Nancy Suchman (2006)
What did Mayes and Suchman conclude about combinations of risk factors
Different combinations partly determine the nature and severity of an addiction.
Are all of the risk factors mentioned always negative
Explain
Which risk factor is never positive
No
Personality traits, genetic characteristics, family and peer influences can reduce risks of addiction.
Stress
What is a more realistic way to view risk factors
View risk factors as multiple ‘pathways’ to addiction which include different combinations interacting and some having a positive effect.
What is one strength of looking at risk factors together
They point to the overriding interaction with genes.
Most risk factors are proximate. What does this mean
Example
They act as an immediate influence on addiction
High stress levels directly increase addiction risk as does the personality trade of novelty-seeking.
Who conducted research on the central tole of genes in addiction
Rey et al. (2009)
What did Rey et al. Conclude on the central role of genes in addiction
How we respond to stress and the extent to which we seek novelty are both partly genetic.
What is the most common ultimate risk factor
Genetic vulnerability.
What is withdrawal syndrome
A set of symptoms that develop when an addicted person abstains from or reduces their substance abuse.
Are withdrawal symptoms the same for all drugs
Are withdrawal symptoms predictable
No
Yes
What is the common link between substance and withdrawal symptoms
Give an example
The symptoms are almost always the opposite of the ones created by the substance
Smoking relaxes you so when you stop anxiety is heightened
Give an example of an active ingredient
Nicotine
Alcohol
What does the existence of withdrawal indicate
Physical dependence has developed
Why does withdrawal symptoms cause further addiction
An addicted person experiences withdrawal whenever they dont have the addictive substance
These withdrawal symptoms are unpleasant and cause discomfort
Motivation to continue with the drug is avoidance of withdrawal syndrome
Taking a substance to avoid withdrawal syndrome is called
A secondary form of psychological dependence
Name the two phases of withdrawal
- The acute withdrawal
- The prolonged withdrawal
How long does acute withdrawal last
Begins within hours
Deminished over days
How long does the prolonged withdrawal phase last
Weeks, months and even years
What are the symptoms of acute withdrawal
Intense cravings reflecting strong physiological and psychological dependence
What are the symptoms for prolonged withdrawal phase
Example
What does this mean
The person becomes highly sensitive to the cues they associate with the substance.
E.g. lighters, rituals, locations
This is why relapse is so common.
What type of dependence does withdrawal indicate
Physical dependence
What are the two plausible direct mechanisms that create a genetic vulnerability to addiction
D2 receptor
Nicotine enzyme (CYP2A6)
Explain how dopamine transmission is effected
What is this controlled by
By the number of dopamine receptors
This number is genetically controlled
What type of receptor is D2
A Dopamine receptor
What is the correlation between D2 and addiction
Explain how it leads to addiction
People who are addicted have been found to have an abnormally low number of D2 receptors.
Fewer receptors means less dopamine activity, so using drugs is a way of compensating for this deficiency
Who researched Nicotine enzyme CYP2A6
Micheal Pianezza et al. (1998)
What did Micheal Pianezza et al. Find out about the enzyme CYP2A6
What does this mean for addiction
Some people lack a fully functioning enzyme which metabolises nicotine.
These people smoke significantly less than those smokers with the fully functioning version.
What is the nicotine enzymes scientific name
CYP2A6
What is the expression of the CYP2A6 enzyme determined by
Genetics
Who highlighted the role of adverse childhood experiences in later addiction
Susan Andersen and Martin Teicher (2008)
What does ACEs stand for
Adverse Childhood Experiences
What do Anderson and Teicher argue about stress and ACEs
Early experiences of severe stress have damaging effects on a young brain n a sensitive period of development.
This creates vulnerability to later stress.
How does Andersen and Teichers argument link to addiction
Further experiences in adolescence and adulthood trigger the early vulnerability and make it more likely that a person will self-medicate with drugs or other behavioural addictions
Is there such thing as a generally addictive personality
What type of personality is linked to addiction
No
Linked to disordered personality.
What disorder is linked mostly to addiction
Who says this
Antisocial personality disorder (APD)
Petry (2002)
Who argues that APD is a causal risk for addiction
Lee Robins (1998)
What is Lee Robins argument for APD and addition
That APD is a causal risk factor because having APD means that a person breaks social mores, is impulsive and may behave criminally
Why will people with APD try drugs
When are they most likely to do it
Drug-taking offers a combination of norm-breaking, criminal activity whist satisfying desires
At a young age
What is the study for family influences on addiction
Jennifer Livingston et al. (2010)
What did Jennifer Livingston find on family influences and addiction to alcohol
Final-year high-school students who were allowed to drink alcohol at home were significantly more likely to drink excessively the following year at college.
What role does adolescent’s perception play in addiction
Adolescents who believe that their parents have little or no interest in monitoring their behaviour are more likely to develop an addiction.
Who suggested that there are 3 major elements to peer influence a s a risk factor for alcohol addiction
Mary O’Connell et al. (2009)
What are the 3 major elements to peer influence as a risk factor for alcohol addiction
- An at-risk adolescent’s attitude and norms about drinking are influences by associating with peers who use alcohol.
- Experienced peers provide more opportunities for the at-risk individual to drink
- An individual overestimates the amount their peers are drinking, they drink more to keep up with the perceived norm
What is the underlying matter of peers and addiction
A group normally that favours rule-breaking generally
Substance addiction is one instance of this
What is a strength of genetic vulnerability as a risk factor for addiction
Support from adoption studies
Who carried out the adoption studies focusing on genetic vulnerability for addiction
Kenneth Kendler et al. (2012)
What was Kendlers method when investigating adoptive studies and addiction
He used data from the National Swedish Adoption Study.
They looked specifically at adults who had been adopted away, as children, from biological families in which as least one parent had addiction.
What was Kendlers findings on genetic vulnerability and addiction
The children later has a significantly greater risk of developing an addiction themselves, compared with adopted-away individuals with no addicted biological parent.
What other research supports the link between genetic vulnerability and addiction
Twin studies
What is one limitation of reserach into stress as a risk factor for addiction
The issue of causation
What have many studies show about the link between stressful experiences and addiction
That there is a positive correlation
What is the key matter for stress as a risk factor for addiction
Explain via example
It matters whether stress or addiction comes first
Some people become addicted with not a significantly stressful experience. Their addiction causes greater levels of stress due to negative effects.
This would still produce a positive correlation but addiction caused the stress.
What is one strength of personality as a risk factor for addiction
Support for the link between addiction adn APD
What link between APD and alcohol dependence is shown in many studies
That they are co-morbid
Who investigated whether APD is actually a causal factor for addiction
Miriam Bahlmann et al. (2002)
What was Bahlmann’s method for investigating APD and addiction
They interviewed 55 alcohol-dependent people
What was Bahlmann’s findings on alcohol addiction and APD
Of 55 interviewed 18 weer also diagnosed with APD.
For these 18 participants APD developed 4 years before their alcohol addiction on average.
What is one strength for family influence as a risk factor for addiction
Research support
Who investigated family influences as a cause for addiction
Bertha Madras et al (2019)
What was Madras findings on family influences as a risk factor for addiction
Found a strong positive correlation between parents use (abuse) of cannabis and their adolescents use of cannabis, nicotine, alcohol and opioids.
What are the two reasons behind family influences leading to addiction
May be that adolescents observe their parents using a specific drug and model this behaviour.
May also infer that their parents approve of drug use, so go on to use other drugs.
What is one strength of peers as a risk factor for addiction
Real-world application
Who is doing an intervention to change mistaken beliefs about how much peers are drinking
SNMA
Social Norms Marketing Advertising
What is SNMA doing to change mistaken beliefs on how much peers drink
Examples with fact
Using mass media advertising to provide messages and statistics about how much people really drink
Beer mats, posters and leaflets in a Student Union bar with messages such as ‘Students overestimate what others drink by 44%’
What is neurochemistry
Relating to chemicals in the brain that regulate biological and psychological functioning
What is dopamine
A neurotransmitter that generally has an excitatory effect and is associated with the sensation of pleasure
Who came up with the desensitisation hypothesis of nicotine addiction
John Dani and Steve Heinemann (1996)
What neurotransmitter plays a key role in all nervous system activity and is key in the role of dopamine
Acetylcholine (ACh)
Where can ACh receptors be found
On the surface of many neurons in the central nervous system
What is the subtype of ACh receptor called
Nicotinic acetylcholine receptor (nAChR)
What is special about nAChR receptors
They can be activated by both dopamine and nicotine
What occurs at the nAChRs when a person smokes
When nAChRs are activated by nicotine molecules, the neuron transmits dopamine.
This is immediately followed by a shutdown.
Within seconds the nAChRs shut down and temporarily cannot respond to any neurotransmitters.
The neurone is desensitised and this leads to downregulation, a reduction in the number of active neurons because fewer of them are avaliable.
What is a desensitised neuron
One that is shutdown and temporarily cannot respond to any neurotransmitters
What is downregulation
A reduction in the number of active neuron’s because fewer of them are avaliable
Where are nAChRs concentrated
In the ventral tegmental area (VTA) of the brain.
When nAChRs are stimulated by nicotine how and where is dopamine transmitted
Dopamine is transmitted along the Mesolimbic pathway
To the Nucleus accumbens (NA)
What does the movement of dopamine into the Nucleus Accumbens trigger
The release of more dopamine from the Nucelus Accumbens into the Frontal Cortex
When dopamine is being transmitted along the mesolimbic pathway where else is it being transmitted to and how
Directly to the frontal cortex
On the mesocortical pathway
Name both the pathways to the frontal cortex and where the dopamine is flowing from in the brain
Ventral tegmental area ——mesolimbic pathway——> Nucelus accumbens ——> Frontal Cortex
Ventral tegmental area ——Mesocorical Pathway——> Frontal Cortex
What are both of the pathways part of
The dopamine reward system
What activates the dopamine reward system
Nicotine
What are the pleasurable effects of nicotine
Mild euphoria, increased alertness, reduction of anxiety
What happens to nicotine and nAChRs and dopamine neurons when someone doesnt smoke for a long period of time
- KEY WORDS
Nicotine disappears from their body
The nAChRs become functional again, so dopamine neuron’s resensitise and more become available
Upregulation
What is upregulation
The nAChRs become functional again, so dopamine neuron’s resensitise and more become available
Explain withdrawal in terms of nAChRs
During resensitisation nAChRs become over stimulated by ACh - as there is no nicotine to bind
NAChRs are most sensative at this point
When are nAChRs most sensative
During resensitisation
Why is the first cigarette of the day most enjoyable
It reactivates the dopamine reward system
Describe dependence in terms of nAChRs
Do so through night-time and day-time changes
There is a constant cycle of daytime downregulation and night-time upregulation.
This causes longterm desensitisation of nAChRs - causing dependence.
Describe tolerance in terms of nAChRs
Continuous exposure of nAChRs to nicotine causes permanent changes to brain neurochemistry
It decreases the number of active receptors.
Tolerance therefore develops as a smoker must smoke more to get the same effects.
What is one strength of dopamine explanations of nicotine addiction
Support from human research
Who has conducted research that supports dopamines explanation of nicotine addiction
Joseph McEvoy et al. (1995)
What did McEvoy study - dopamine explanations of nicotine addiction
Method
Studied smoking behaviour in people with schizophrenia where were taking the antipsychotic drug Haloperidol.
In McEvoy’s study why did he focus on schizophrenia patients taking Haloperidol
Haloperidol is a dopamine antagonist - blocks dopamine receptors in the brain, reducing dopamine transmissions
What was McEvoy’s findings in his reserach on smoking behaviour in people with schizophrenia
Explain
The people taking Haloperidol showed a significant increase in smoking.
This is a form of self-medication.
Individuals used the nicotine as a means of increasing their depleted dopamine levels.
What is a counterpoint to research support for dopamine explanations of nicotine addiction
Explanations of nicotine that consider only the role of dopamine are limited.
The dopamine system is central but research increasingly shows a complex interaction of several neurochemical systems
Why did research on the other neurochemical systems that may be involved in nicotine addiction
Shelley Watkins et al. (2000)
What did Watkins say the other neurochemical systems are
Neurotransmitter pathways e.g. serotonin
Endogenous opioids (endorphins)
What is another strength that neurochemistry does
Leads to new treatments
Give an example of neurochemistry leading to new treatments
Nicotine replacement therapy (NRT)
Name 3 examples of NRT
Patches
Gum
Inhalers
How do Nicotine Replacement Therapies work (NRT)
They deliver controlled doses of nicotine
Acts neurochemical by binding with nAChRs and mimicking the effects of nicotine, including dopamine release.
Satisfies cravings and allows safe withdrawal.
What is the limitation of the neurochemical explanation
It does not fully explain withdrawal
What do withdrawal symptoms mainly depend upon
The nicotine blood concentration levels in the body.
Who is the study for neurochemical explanations not fully explaining withdrawl
David Gilbert (1995)
What did Gilbert point out about withdrawal not being fully explained by neurochemistry
Blood level concentrations do not strongly correlate with the severity of withdrawal symptoms.
What did Gilbert argue instead about what withdrawal depends upon
Example
Withdrawal depends much more on environment and personality.
Those who score higher on the personality dimension of neuroticism generally experience worse withdrawal symptoms than those who are emotionally stable/
Who states that some people can smoke without becoming dependent or experience withdrawal
Shipman and Paty (2006)
What did shipman and patty state
What is this called
Some people smoke without becoming dependent and show no signs of withdrawal
Determinism
Why does shipman and pattys statement contradict the neurochemical explanation for nicotine addiction
The neurochemical explanation is biologically determinist suggesting we become addicted due to chemical events.
It suggests nicotine addiction is inevitable.
What is the learning theory
A behaviourist explanation based on the mechanisms of classical and operant conditioning such as positive and negative reinforcement.
What type of conditioning is cue reactivity an example of
Classical conditioning
Is nicotine a strong reinforcer
Yes
Explain how nicotine is a positive reinforcement
Nicotine stimulates the dopamine reward system.
When someone has a cigarette they experience mild euphoria which the smoker finds rewarding and positively reinforces their smoking behaviour.
Who stated that positive reinforcement can explain the early stages of smoking
George Koob and Michel Le Moal (2008)
What stage of smoking is positive reinforcement involved in
The early stages of
What stage of smoking is negative reinforcement
A smoker’s continuing dependence on nicotine
Explain how negative reinforcement plays a role in smoking
Negative withdrawal symptoms occur when a smoker stops smoking.
The smoker smokes another cigarette which is negative reinforcing because it stops an unpleasant stimulus.
What are the pleasurable effects of smoking known as
A primary reinforcer
Why are the pleasurable effects of smoking known as a primary reinforcer
It is intrinsically rewarding (not learned) due to its effects on the brain’s dopamine reward system
What are secondary reinforcers
Any other stimuli that is present at the same time or just before that become associated with this pleasurable effect.
Give examples of secondary reinforcers for smoking
Areas such as pub gardens or smoking areas
Friends who also smoke
Smell of tobacco
A favourite lighter
What do all secondary reinforcers act as?
Why
Cues
Because their presence produces a similar physiological and psychological response to nicotine itself.
What are the three main elements of cue reactivity?
- Subject desire or craving for a cigarette, which is self-reported
- Physiological signs of reactivity, including autonomic responses such as heart rate and skin temperature
- Objective behavioural indicators such as how many ‘draws’ are taken on a cigarette and how strongly
What is the definition of cue reactivity
Cravings and arousal can be triggered in, for instance, nicotine addicts when they encounter cues related to the pleasurable effects of smoking.
What is one strength for the learning approach to addiction
Support through animal studies
There is a substantial body of research with non-human animals confirming the role of operant conditioning in nicotine addiction
Who completed a study on operant condition and nicotine addiction
Edward Levin et al. (2010)
What was the method to Levins research on operant conditioning
Rats could lick two water spouts.
Licking one spout caused an intravenous dose of nicotine.
What was Levins results on his research with rats on operant conditioning and nicotine addiction
The rats licked the nicotine-linked waterspout significantly more than often.
The number of licks increased over 24 hrs.
What are the limitations to Levis research on operant conditions and nicotine addiction
Human-animal comparisons are flawed because nicotine addiction in humans is more complex due to cognitive factors.
Ethical issues with using animals for experimentation.
What is the positive of using animals in research on conditioning and nicotine addiction
The conditioning mechanisms involved in nicotine addiction are the same in humans and other mammals (according to behaviourists)
More ethical to use animals over humans.
What is a strength for cue reactivity and its link to nicotine addiction
There is research with humans for the effects of
Who conducted a meta-analysis on cue reactivity in humans for nicotine addiction
Brian Carter and Stephen Tiffany (1999)
What did Carter and Tiffany do in their research on cue reactivity and nicotine addiction
What did studies involve
Conducted a meta-analysis of 41 studies into cue reactivity
The studies presented dependent, non-dependent and non smokers with images of smoking-related cues.
What was measured in the studies in the meta-analysis conducted by Carter and Tiffany
Self-report desire was measured along with indicators of physiological arousal (heart rate)
What was the results of Carter and Tiffany’s meta-analysis on cue reactivity and addiction
Dependent smokers reacted most strongly to the cues and reported stronger cravings even when nicotine wasn’t present.
What strength does nicotine treatment programmes prove
They are based on classical conditioning principles.
What does aversion therapy use to treat nicotine addiction
Countercondition
What therapy uses counterconditoning to treat nicotine addiction
Aversion therapy
How is counterconditioning done to treat nicotine addiction
It associated the pleasant effects of smoking with an aversive stimuli e.g. an electric shock
Who researched aversion therapy for nicotine addiction
What was the method
James Smith (1988)
Smokers gave themselves aversive electric shocks whenever they engaged in any smoking-related behaviours
What was the results of smiths research on counterconditioning
Compare this to the usual rates (2 Facts)
After one year 52% of the participants were still abstaining.
Usually 20-25% of people continue not to smoke after deciding to give up.
What is the counterpoint to Smith’s research on counterconditioning as a treatment for nicotine addiction
The study did not use a control (placebo) group.
The comparison of the proportion of people who continue not to smoke is not a valid measure of effectiveness.
Who provided evidence in a higher-quality study that the benefits of aversion therapy are relatively short-lived compared to other therapies
Hajek and Stead (2001)
What is the negative to aversion therapies compared to others
It has a shorter temporal effect.
What is reinforcement
A consequence of behaviour that increases the likelihood of that behaviour being repeated.
Can be positive or negative
What is the first component in the learning theory of gambling addiction
Vicarious reinforcement
Seeing others be rewarded for their gambling through pleasure, enjoyment and money.
What are the two sources of direct positive reinforcement for gambling
Winning money
The adrenaline rush that accompanies a gamble
Explain how gambling can have a negative reinforcement
It can be a distraction from aversive stimuli
A distraction from the anxieties of everyday life
What is the overall specific types of reinforcement seen in gambling
Partial reinforcement
What is partial reinforcement
A behaviour is reinforced only some of the time it occurs
E.g. every tenth time or at variable intervals
What is a sub type of partial reinforcement
Variable reinforcement
What is variable reinforcement
A type of partial reinforcement in which a behaviour is reinforced after an unpredictable period of time or number of responses.
What takes longer under variable reinforcement
Learning - it produces the most persistent learning
What happens once learning is established in variable reinforcement
It is much more resistant to extinction
Why does variable reinforcement lead to gambling addictions
The gambler learns that they will not win with every gamble, but they will eventually win if they persist.
What else can explain why a behavioural action like gambling can be maintained and reinstated after relapse
Cue reactivity
What are some of the secondary reinforcers a gambler may experience
The atmosphere of a betting shop
The colourful look of a lottery scratch card
Sounds of internet betting sites
What is one strength for positive reinforcement in gambling
Support from research outside the lab situation
Who conducted research on positive reinforcement for gambling addiction
Mark Dickerson (1979)
What was Mark Dickersons method for researching positive reinforcement and gambling addictions
He observed the behaviour of gamblers in two betting offices in Birmingham.
He compared gamblers who placed few bets (low-frequency) on horse races with high-frequency betters.
What was Dickersons findings for positive reinforcement in gambling addictions
What do they mean
High-frequency gamblers were consistently more likely to place their bets in the last 2 minutes before the start of the race.
Suggested that all gamblers find the build-up exciting regardless of the result, especially dependent ones.
What is a counterpoint to Dickersons research on positive reinforcement in gambling
Methodological shortcomings.
Observed over 14 weeks by 1 observer - no one checking reliability.
Observer bias is not eliminated and findings may be invalid
No inter-observer reliability
What is one limitation to the learning theory
It struggles to explain some types of gambling
What type of gambling is it harder for the learning theory to explain
Why
Addiction to gambling in which the outcome is known some time after placing the bet.
The reward comes a long time after the behaviour so conditioning should be less effective
What is a strength of the learning theory
It explains why most gamblers cannot stop
Explain how the learning theory shows how gambling can be maintained
Conditioning is an ‘automatic’ process and doesnt require a gambler to make decisions.
They are not aware they are learning to be addicted.
Conscious desire to give up conflicts with the conditioning.
Outline the cycle of gambling addiction
Initiation, maintenance, cessation and relapse
Addiction begins through what reinforcement
Vicarious
What explains why so many addicted ga,bless relapse after abstaining
Cue reactivity
Who suggests that learning theory actually struggles to explain gambling addiction
Iain Brown (1987)
What part of the cycle does Brown suggest learning theory cannot explain and why
Addiction
Many people who gamble and experience the same reinforcements are not addicted.
Expectations are central to what part of gambling
Initiation
What do people who take up gambling expect
How are they wrong
The benefits will outweigh the costs
Some people overestimate the benefits and underestimate the costs
What is a common unrealistic expectation about gambling
How it will help them cope with their emotions
People with distorted expectations of gambling are more likely to ____
Become addicted
Why do gamblers continue to gamble
They have a cognitive bias
What is a cognitive bias
A distortion of attention, memory and thinking.
Arises because of how we process information about the world, especially when we do it quickly.
What can cognitive bias lead to
Irrational judgements and poor decision-making
Who classified cognitive bias into 4 categories
Debra Rickwood et al. (2010)
List the 4 categories for cognitive bias
- Skill and judgement
- Personal traits / ritual behaviours
- Selective recall
- Faulty perceptions
Outline skill and judgement - 4 categories of cognitive bias
Addicted gamblers have an illusion of control which means they overestimate their ability to influence a random event. (Lottery)
Outline Personal traits/ritual behaviours - 4 categories of cognitive bias
Addicted gamblers believe that they have a greater probability of winning because they are especially lucky or they engaged in some superstitious behaviour (touching a certain item of clothing before a bet)
Outline Selective recall - 4 categories of cognitive bias
Gamblers can remember the details of their wins but they forget, ignore or minimise their losses, which are often interpreted as unexplainable mysteries.
Outline Faulty perceptions - 4 categories of cognitive bias
Addicted gamblers have distorted views about the operation of chance, exemplified in the so-called gambler’s fallacy, the belief that a losing streak cannot last and must always be followed by a win
What is self-efficacy
Refers to the expectations we have about our ability to achieve a desired outcome.
Where in the gamblers cycle does self-efficacy play a part
A key element in relapse
What type of process is self-efficacy
Why
A cognitive process
It is based on expectations and perceptions
Explain how self-efficacy results in relapse
A person has a biased belief that they are not capable of abstaining permanently.
They expect to gamble again.
Sets up a self-fulfilling prophecy.
What is self-fulfilling prophecy
An individual behaves in a way that confirms their expectations (“I told you so”)
This is in turn reinforced
Who investigated cognitive biases in gamblers
Mark Griffith (1994)
What was Griffith procedure for investigating cognitive biases in gamblers
(KEYWORDS)
Used the ‘thinking aloud’ method (introspection) to compare the cognitive processes of regular slot machine gamblers and people who used the machines only occasionally.
Participants had to verbalise all thoughts.
A content analysis classified the thoughts into rational or irrational.
Behavioural measures were also recorded (total winnings)
A semi-structured interview was used to ask participants about the degree of skill required to win on slot machines.
Name and describe the interview methods used in Griffiths investigation on cognitive bias in gamblers
A semi-structured interview was used to ask participants about the degree of skill required to win on slot machines.
What did Griffiths find in his investigation on cognitive biases in gamblers
Wins and verbalisations
There was no differences between regular and occasional gamblers in objective behavioural measures (regulars didnt win more money)
Regular gamblers made almost 6x as many irrational verbalisations than the rest (14% compared with 2.5%)
What were the regular gamblers prone to in Griffiths investigation on cognitive biases in gamblers
They were particularly prone to an illusion of control.
What is one strength of the cognitive theory
The support for the role of cognitive biases
Who researched cognitive biases for the cognitive theory
Rosanna michalczuk et al, (2011)
What was the method for Michalczuk reserach on cognitive bias in gambling
Studies 30 addicted gamblers attending the National Problem Gambling Clinic in the UK.
Compared them with 30 non-gambling control participants.
What was the result of Michalczuk research on cognitive bias in gambling
The addicted gamblers showed significantly higher levels of gambling-related cognitive biases of all types.
The gamblers were more impulsive and more likely to prefer immediate rewards even when the rewards were smaller than rewards they could gain if they waited.
What does impulsive gambling decisions show about the cognitive theory
Because addicted gamblers make gambling decisions impulsively, they have a powerful tendency towards biased thinking during play.
Shows a strong cognitive component to gambling addiction
What is the counterpoint to Michalczuk’s findings on the link between cognitive bias and gambling addictions
Cognitive biases were measured using the Gambling-related cognitions scale (GRCS).
This scores respondents on five types of bias.
The score could mean the gamblers have high frequency biased cognitions (what researchers concluded) or the score might reflect a gambler’s tendency to use their beliefs to justify their behaviour.
Therefore wouldnt be bias at all.
Who else’s reserach supports cognitive biases
George McCusker and Briege Gettings (1997)
What was McCusker and Gettings method when researching cognitive biases
Used a modified stroop task.
What did McCusker and Gettings find on cognitive bias using a stroop task
Addicted gamblers took longer to perform this task than controls but only when the words related to gambling.
They were unable to prevent the word meanings from interfering with the intended task.
What is one methodological problem in methods used to assess cognitive bias
The use of ‘thinking aloud’ in research
How pointed out the issue with ‘thinking aloud’ method
Mark Dickerson and John O’Conner (2006)
What did Dickerson and O’Conner say about the thinking aloud method
What people say in gambling situations does not necessarily represent what they really think.
Off-the-cuff remarks during gambling may not reflect an addicted gamblers real thoughts about chance and skill.
Why might cognitive bias not truly explain gambling addiction
They are only proximate causes
Have to go further back in the chain of causation to find the ultimate explanation
What is drug therapy
Treatment involving drugs.
What are the three main types of drug therapy for addiction
Aversives
Agonists
Antagonists
What is the main effect of aversives
To produce unpleasant consequences such as vomiting.
What type of conditioning are aversives
Classical
Explain the example of aversives and alcohol
Disulfriam is a drug given to alcoholics.
It causes the effects of a severe hangover (especially nausea) 5 mins after an alcoholic drink.
Alcohol is then associated with unpleasant outcomes
What are agonists
Drug substitutes that control withdrawal syndrome
How do agonists work
They activate neuron receptors providing a similar effect to the addictive substance
Give an example of an agonist
What a re the benefits
Methadone is given to heroin addicts
Satisfy cravings, fewer harmful side effects, cleaner.
How do antagonists work
They treat addiction by blocking receptor sites so that the substance of dependence cannot have its usual effects.
Especially the effect of euphoria
Give an example of an antagonist
What else should be done
Naltrexone is an opioid antagonist used to treat psychological dependence of heroin addiction.
Other interventions such as counselling should be used alongside drug therapy.
How does NRT help nicotine withdrawal
It provides the user with a clean, controlled dose of nicotine which operates neurochemical y as an agonist activating nAChRs
What steps are taken with NRT to ease symptoms and slow withdrawal
Nicotine is reduced over time by reducing the number of mg of nicotine within patches or gum.
Are there drug therapies approved for gambling addiction
No
What is the most promising drug from gambling addicts
What is the type of drug and whats its name
Opioid antagonists
Naltrexone
What information came out in DSM-5 that has led to the idea of drug therapy for gambling addictions
The neurochemical explanation if gambling addiction is that it tap into he same dopamine reward system as drugs.
How do opioid antagonists work
Key words and depth
They enhance the release of the neurotransmitter GABA in the mesolimbic pathway.
Increased GABA activity reduces the release of dopamine in the nucleus accumbens (and frontal cortex).
What is one strength of drug therapy
Research shows it is effective
Who conducted research on the effectiveness of NRT
Jamie Hartmann-Boyce et al. (2018)
What was Hartmann-Boyce’s method when looking at NRT effectiveness
How many participants
They conducted a meta-analysis of 136 high-quality research studies.
Almost 65,000 participants
What did Hartmann-Boyce find about the effectiveness of NRT
Fact
All forms of NRT were significantly more effective in helping smokers quit than both placebo and no therapy.
NRT products increased the rate of quitting by 60%.
What did Hartmann-Boyces finding also suggest about NRT
Research indicated that NRT does not appear to foster dependence
What is a counterpoint to Hartmann-Boyce’s findings
The researchers only included in their analysis research studies that has been published.
There is a risk of publication bias because published studies are more likely to show ‘positive’ results.
What is a strength of drug therapy
Addiction becomes less stigmatised through its association with drug therapies.
It encourages the perception that drug addiction has a neurochemical basis.
What is the stigma with drug addiction
What can this cause for people with drug addiction
That it is a psychological weakness
Can lead to self-blame and depression, making recovery more difficult.
What are two more major positives to drug therapy
Drugs are cost-effective and dont disrupt peoples lives as much as therapy would
What is one limitation of all drug therapies
They have side effects
What is the biggest risk of side effects in drug therapies
Clients will discontinue the therapy even if the side effects are minimal and will be short-lived.
Another reason to go back to the drug
What are the common side-effects of NRT
Sleep disturbances, gastrointestinal problems, dizziness and headaches.
Does drug therapy for gambling addictions have better or worse side effects than for nicotine
Worse
Explain why the side effects for drug therapy to treat gambling addictions are worse
The dose required for naltrexone to have an effect on gambling addiction is much higher than when used to treat opioid addiction.
The side effects are worse.
What are the side effects of using Naltrexone on gambling addictions
Muscle spasms, anxiety and depression.
What must always been considered before drug therapy
Side effects should be weighed up against the benefits of drug therapy and the costs / benefits of other therapies.
What type of intervention is aversion therapy
A behavioural intervention
What is behavioural intervention
Any treatment based on behaviourist principles of learning such as classical and operant conditioning
What is aversion therapy
A behavioural treatment based on classical conditioning.
A maladaptive behaviour is paired with an unpleasant stimulus such as a painful electric shock.
Eventually the behaviour is associated with pain without the shock being used.
What is it called when you change conditioning
Counterconditioning
Give an example of aversion therapy
Using the drug Disulfriam from alcoholics
Explain Disulfriam and alcohol in terms of classical conditioning
Through association they become conditioned stimuli producing an expectation of nausea which is a conditioned response
When is an electric shock used in aversion therapy
Treatment of behavioural addictions and for people who’s medical conditions (e.g. high blood pressure) may be worsened by frequent vomiting.
Explain how electric shock therapy is performed on gambling addicts
An addicted gambler thinks of phrases that relate to their gambling behaviour and writes them down along with non-gambling behaviours on card.
The client reads out each card and when they get to a gambling-related phrase they are given a 2 second electric shock via a device attached to their wrist.
What is the key rule with electric shock therapy
Should be painful but not distressing
What is the pain called before and after the therapy
It was an unconditioned response and a neutral stimuli
Now a conditioned stimuli
When was aversion therapy most popular
60s and 70s
What therapy has take over aversion therapy
Covert sensitisation
What type of conditioning is covert sensitisation based on
Classical
What is covert sensitisation
A form of aversion therapy based on classical conditioning.
A client imagines an unpleasant stimulus and associates this with a maladaptive behaviour.
What is the difference between aversion therapy and covert sensitisation
In aversion therapy the unpleasant stimulus is actually experienced
In covert sensitisation the client imagines how it would feel
Describe the process of covert sensitisation
Example
Client relaxes
Therapist reads from a script instructing the client to imagine an aversive situation.
The client sees themselves doing the addictive habit followed by imagining the most unpleasant consequences.
Towards the end of the session the client then imagines a scene where they give up the addictive substance and experience relief.
Example: tobacco and vomiting
What makes covert sensitisation more effective
How is this achieved
The more vivid this imaginary scene is the better
Therapists go into graphic detail about the imagery including sights, smells, sounds and physical movements involved.
Who gives a good example of covert sensitisation
Mary McMurran (1994)
What was Mary McMurrans example of covert sensitisation
A habitual user of slot machines had a phobia of snakes.
Got them to imagine the pay out was snakes and not cash.
What is a limitation to the evidence on aversion therapy
Studies have methodological problems.
Who reviewed the methodological problems in studies on aversion therapies
Peter Hajek and Lindsay Stead (2001)
How many studies on what did Hajek and Stead review on evidence for aversion therapy
What did Hajek and Stead conclude
25 studies on aversion therapy for nicotine addiction.
Concluded it was impossible to judge the effectiveness of aversion therapy as most of the studies had ‘glaring’ methodological problems,s.
Give an example of a methodological problem in research on the effectiveness of aversion therapies
There was a failure to ‘blind’ the procedures, so the researchers knew which participants received therapy or placebo
What are two general limitations to aversion therapy
Lack of long-term benefits
It is unethical
Who researched the longevity of aversion therapy
Richard Fuller et al. (1986)
What was Fullers method when investigating the longevity of aversion therapy’s benefits
Gave one group who were addicted to alcohol Disulfriam and the others a placebo every day for a year.
Both groups also had weekly counselling sessions for 6 months
What was Fullers findings when investigation the longevity of aversion therapy
There was no significant difference in total abstinence from drinking between these groups after one year.
Do many people complete aversion therapy
Drop out rates are really high
What are the ethical issues with aversion therapy
It may cause physical and / or psychological harm
Why might someone argue that aversion therapy is ethical
Self-selected small electric shocks may be painful but not life-threatening.
What is one strength for covert sensitisation
There is research support
Who researched the effectiveness of covert sensitisation
Nathaniel McConaghy et al. (1983)
What was McConaghy’s method for researching the effectiveness of covert sensitisation
They compared cover sensitisation and electric shock aversion therapy for gambling addiction.
What was McConaghy’s findings when researching the effectiveness of covert sensitisation
Fact
After one year, those with covert sensitisation were significantly more likely to have reduced their gambling.
90% of covert sensitisation participants reduced gambling compared to just 30% that underwent aversion therapy.
Covert sensitisation patients also reported experiencing fewer and less intense gambling cravings.
What is one limitation of research on covert sensitisation
Many studies of covert sensitisation do not include a suitable comparison group.
What is a limitation to McConaghy’s research on the effectiveness of covert sensitisation
It did not include a suitable comparison group
What is the missing comparison group in a lot of studies investigating covert sensitisation or aversion therapy
A non-behavioural therapy group.
Usually only compare aversion therapy to covert sensitisation.
What does CBT address that neither covert sensitisation or aversion therapy do
Addiction has many non-learning causes (cognitive factors)
Does covert sensitisation or aversion therapy cure addiction
No
What can covert sensitisation lead to
How can this be solved
Symptoms substitution
May appear to recover but the issue that caused addiction remains and new symptoms start to appear.
Covert sensitisation can be used to treat those aswell
What is cognitive behavioural therapy (CBT)
A method for treating mental disorders based on both cognitive and behavioural techniques.
From the cognitive viewpoint the therapy aims to deal with thinking, such as challenging negative thoughts.
The therapy also includes behavioural techniques.
What are the two indispensable elements to a CBT program
Functional analysis
Skills training
What is functional analysis in CBT
It identifies the cognitive biases that underlie addiction, replacing the cognitive biases with more adaptive ways of thinking
Is functional analysis cognitive or behavioural
Cognitive
What is skill training in CBT
Helps a client to develop coping behaviours to avoid the high-risk situations that usually maintain addictions or trigger relapses
Is skills training cognitive or behavioural
Behavioural
How does CBT start - functional analysis
Starts with a client and therapist together identifying the high-risk situations in which the client is likely to gamble or use a substance of addiction.
The therapist reflects on what the client is thinking before, during and after such a situation.
What is extremely important in CBT - functional analysis
That there is a high quality client-therapist relationship
What are good qualities of a patient-therapist relationship - functional analysis
Warm, collaborative and responsive
What must a client-therapist relationship not be and why - functional analysis
Cosy as the therapist must challenge the client’s biased cognitions and not accept them
What does cognitive restructuring do - functional analysis
Example with gambling
Aims to change a client’s addiction-related cognitive biases.
Addresses the clients faulty beliefs.
E.g. probability
What does the therapist does with a clients misbeliefs - functional analysis
Confronts and challenges them
What does functional analysis do in the early stages of therapy
It helps the client identify the triggers for their actions.
What is functional analysis useful for later in therapy
Helping a client to work out their circumstances in which they are still having problems with coping and what further training skills may be needed
What do most people seeking therapy for addiction also have - skill training
A huge range of problems but only one way of coping with them - addiction
What two types of skills can be used in skill training
Specific skills and social skills
Is CBT a broad or narrow treatment
Broad
Why is CBT considered broad-spectrum
It focuses on wider ascpetcs of a clients life that are related to his or her addiction.
What training can be used for people that turn to alcohol when angry
Anger management training
Give an example of what functional analysis may review and what could be used in skills training to solve it
Functional analysis may reveal that a client cannot cope with a situation that triggers alcohol use.
Assertiveness training could be used to help a client confront interpersonal conflicts in a controlled and rational way.
How can social skills training help a recovering alcoholic
It can help them learn how to refuse alcohol with minimum fuss in ways that avoid embarrassment at social gatherings.
How does a therapist usually introduce a new skill
With an explanation of the reasoning behind learning a new skill.
How are skills improved before the client uses them on their own in a high-risk situation
The therapist models the behaviour. The client imitates in role play.
Constant ‘tell and show’
What are two limitations of CBT
It may only be effective in the short-term
Many clients drop out of CBT
Who investigated the longevity of CBT
Sean Cowlishaw et al. (2012)
What was Cowlishaw’s method when investigating the longevity of CBT
Conducted a meta-analysis of 11 studies comparing CBT for gambling with control conditions.
What was Cowlishaw’s findings on the longevity of CBT
Showed that CBT had medium to very large effects in reducing gambling behaviour for period of up to 3 months after treatment.
After 9 to 12 months there were no significant differences in outcomes between the CBT and control groups.
Who conducted research that combatted Cowlishaw’s findings on the longevity of CBT
Nancy Petry et al. (2006)
What was Petry’s method when investigating the longevity of CBT
Randomly allocated pathological gamblers to either a control group (Gamblers anonymous meetings) or a treatment condition (GA meetings plus an eight-session individual CBT programme).
What was Petry’s findings when researching the longevity of CBT
The treatment clients were gambling significantly less than the control participants 12 months later.
What is extremely reliable about Petry’s investigation into the longevity of CBT
The study had high internal validity due to random allocation and there was no significant difference in the extent of their gambling at the start
Who conducted an investigation into the drop out rates of CBT
Pim Cuijpers et al. (2008)
What did Cuijper’s state about dropout rates for CBT
Drop-out rates in CBT treatment groups can be up to 5x higher than for other forms of therapy.
Why might there be such high-drop out rates for CBT
CBT is a demanding form of therapy
Clients often seek CBT because a life crisis caused by addiction has driven them to it. Once the initial crisis is resolved they give up CBT when there are smaller underlying issues at hand.
What is one strength of CBT
Very useful in preventing relapse
How does CBT approach relapses
It is a very realistic therapy and incorporates the likelihood of relapse
Replace is viewed as an opportunity for further cognitive restructuring and learning rather than as a failure.
What is theory of planned behaviour (TPB)
How we can change out behaviour deliberately through rational decisions - we evaluate the positive and negative consequences
Who came up with the theory of planned behaviour
Icek Ajzen (1985, 1991)
What does TPB assert about our behaviour
It can be predicted from our intentions.
What is the aim for TPB and addiction
To link intentions and changes in behaviour
What 3 principles does TPB suggest our intentions to use drugs arise from
Our personal attitudes
Subjective norms
Perceived behavioural control
What are an addicted persons attitudes a combination of
Favourable and unfavourable opinions about their addiction
How are personal attitudes formed for addiction
By the person evaluating the positive and negative consequences of their addiction-related behaviour
When attitudes become unfavourable what happens to addiction
Reduced interest in addiction-related behaviour
What are subjective norms in addiction
The addicted person’s beliefs are about whether those who matter most to them approve or disapprove of their addicted behaviour
What are subjective norm beliefs based on in addiction
What an addicted person believes to be ‘normal’ behaviour.
What does an addicted person consider about their friends and family
What they would think if they knew about their addiction
If an addicted person knows their friends and family dislike their addiction what will the affect on the addicted person be
It will lead them to form an intention not to gamble, and therefore make them less likely to gamble.
What is important about the source of the information an addicted person sees.
Why?
It has to be credible
Our subjective norms are most influenced by views of people we respect
What is perceived behavioural control
How much control we believe we have over our own behaviour
Self-efficacy for example.
What does a gamblers believe on how easy it is to give up depends upon in perceived behavioural control
Depends on their perception of the resources available to them, both external and internal.
According to TPB what are the two possible effects that perceived behavioural control can have
Are these direct or indirect influences on behaviour
- It can influence our behaviour indirectly via our intentions to behave. The more i believe i can stop gambling the more likely i will.
- The greater my perceived control over my gambling the longer and harder i will try to stop. The only TPB component that will directly influence behaviour
Increasing a gamblers self-efficacy will result in what?
Could help them quit and/or avoid relapse
What should be made clear to an individual going through withdrawal
It will require willpower
How can you increase the self-efficacy of someone trying to quit an addictive substance
Encouraging an optimistic outlook and confidence in their ability not to gamble.
What is one strength of TPB
There is research evidence to support it
Who conducted research on TPB
Matin Hagger et al. (2011)
What was Hagger’s method when reseraching TPB
486 participants completed questionnaires about their alcohol-related behaviours.
They completed the same questionnaires after one month and after three months.
What did Hagger’s investigation on TPB find?
Personal attitudes, subjective norms and perceived behavioural control all correlated significantly with the intention to limit drinking to the guideline number of units.
What did Hagger’s investigation also find on intention
Intentions were also found to predict the number of units actually consumed after one and three months.
What did Hagger’s investigation find out about perceived behavioural control
Perceived behavioural control predicted actual unit consumption directly and not just intention.
What is the counterpoint to Hagger’s investigation on TPB
The study failed to predict some alcohol-related behaviours.
What alcohol-related behaviours failed to be predicted in Hagger’s research on TPB
Attitudes, norms, control and intentions did not correlated significantly with the number of binge-drinking sessions after one and three months.
What does Hagger’s findings suggest about the success of TPB
It may depend on the type of addiction-related behaviour being measured.
What are the limitations of TPB
Short-term effects only
TPB cannot account for the intention-behaviour gap.
Who researched the longevity of TPB
Rosie McEachan et al. (2011)
What was McEachan’s method when researching the longevity of TPB
Conducted a meta-analysis of 237 tests of the TPB in predicting health behaviours including addiction-related ones
What did McEachan find about the longevity of TPB
The strength of the correlation between intentions and behaviour varied according to the length of time between the two.
Intention to stop drinking can predict actually giving up drinking but only if the time between intention and bahaviour is less than about 5 weeks.
What does McEachan’s results for longevity of TPB suggest about intentions being used for predictions
Intentions may not predict changes to addiction-related behaviour in the long-term.
Who investigated the intention-behaviour gap
Rohan Miller and Gwyneth Howell (2005)
What did Miller and Howell study in relation to intention-behaviour gap
They studies the gambling behaviour of underage teens.
What did Miller and Howell find about the intention-behaviour gap in TPB
Strong support for some parts of the TPB but the key element of the TPB was not supported.
Intentions were not related tot he actual gambling behaviour.
What does TPB claim about decisions being made
Why is this a flaw
Claims that addiction is the result of rational decisions
Decisions may not be rational as many factors including emotions and stress can make decision making irrational and this is not explained by TPB
Who notices that smoker’s behaviour changes during the time that they were trying to quit
James Prochaska and Carlo DiClemente (1983)
Who came up with the six-stage model of behaviour change
It is Prochaska’s six-stage model
What does Prochaska’s six-stage model recognise is not the case about overcoming addiction
It recognises that is does not happen quickly or in a tidy linear order from start to finish.
What type of process is Prochaska’s six-stage model
It is not a single event but a cyclical process.
Describe how Prochaska’s six-stage model is a cyclical process
Clients progress through stages but they also return to previous ones, and some stages may be missed out altogether.
What two major insights is Prochaska’s six-stage model based on
- People who are addicted differ in how ready they are to change their behaviour.
- The usefulness of treatment intervention depends on the stage the person is currently in.
Name the six stages in Prochaska’s six-stage model
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Termination
Draw the diagram for Prochaska’s six-stage model
What is Prochaska’s six-stage model
Definition / summary
This explains the stages people go through to change their behaviour. It identifies six stages of change, from not considering it at all to making permanent changes. The stages are not necessarily followed in a linear order.
What are people doing in the stage of precontemplation
Not thinking about changing their addiction-related behaviour in the near future.
How long must a person be not wanting to change their addiction for in precontemplation
The next 6 months
Why might someone be in the stage of precontemplation
Denial and/or demotivation
What is the intervention in the stage of precontemplation
Intervention should focus on helping the person to consider the need for change
What is a person thinking at the contemplation stage
They are thinking about making a change to their behaviour.
What is the time period for contemplation
Changing behaviour in the next 6 months.
Does a person in the contemplation stage need to have decided to make change
No they are just increasingly aware of the need for change.
How long can people remain in the contemplation stage
People can remain in a chronic stage of contemplation for a long time
What is the most useful intervention in the contemplation stage
Help the person finally see how the pros of overcoming addiction outweigh the cons
What does a person think in the preparation stage
The individual believes that the benefits are greater than the costs. They decide to change their addiction-related behaviour
In what time period has a person decided to make change in the preparation stage
They will change their addiction-related behaviour some time in the next month.
What have people not decided when in the preparation stage
Haven’t yet decided exactly how and when to change.
What is the most useful form of intervention in the preparation stage
To support in constructing a plan, or in presenting them with some options.
Example: seeing a drugs counsellor or making a gp appointment
What are people doing in the action stage
People at this stage have done something to change their behaviour.
In the action stage what time period does someone have to have made a change to their behaviour
In the last 6 months
What type of therapies may be effective in the action stage
Cognitive and behaviour therapies
What informal action may someone in the action stage take.
Give 2 examples
Cut up their cigarettes
Pour all the alcohol in the house down the sink
The actions a person takes in the action stage must do what
Substantially reduce their risk.
What is effective intervention in the action stage
Focuses on developing the coping skills the client will need to quit and maintain their change of behaviour into the next stage.
What is a person doing in the maintenance stage
The person has maintained some change of behaviour
How long does someone have to have changed their addictive behaviour for to be in the maintenance stage
More than 6 months
What is the general focus on in the maintenance stage
What must be avoided
Relapse prevention
Avoiding situations where cues might trigger addiction
What happens to a persons confidence in the maintenance stage
Become more confident that abstaining can be continued in the long term because it is becoming a way of life
What does intervention focus on in the maintenance stage
Relapse prevention, and aims to help the client to apply the coping skills they have learned and use the sources of support available to them.
What is a person doing at the termination stage
Newly acquired behaviours such as abstinence become automatic.
The person no longer returns to addictive behaviours to cope with anxiety, stress or loneliness.
Do all people reach termination
This stage may not be possible or realistic for some people to achieve
What is the most appropriate goal for many going through withdrawal
To prolong maintenance for as long as they can, accepting that relapse is inevitable but providing the person with the skills to work through the earlier stages of the process quickly.
Hat is the most effective intervention in the termination stage
No intervention is required.
What are the strengths of Prochaska’s six-stage model
The model views recovery as a dynamic process
The model views relapse realistically
What have earlier theories suggested about recovery from addiction
Is this view still held by many people
It is a single all-or-nothing event
Yes
What does the six-stage model emphasise about recovery helping it be viewed as a dynamic process
The importance of time, overcoming addiction is a continuing process.
People can skip stages or revisit old ones.
What is a counterpoint to the six-stages being a dynamic process
The stages themselves have been criticised for being arbitrary.
There is no research evidence to distinguish one stage from another.
Who argued against the need for six-stages
Pa Kraft et al. (1999)
What did Kraft argue about the six stages
How many stages does he suggest
They can be reduced or just two useful ones,
Precontemplation then the other stages grouped together.
What are the implications in the six-stage model Kraft highlights
According to Prochaska’s six-stage model, each stage is matched with a particular type of intervention.
Suggests Prochaska’s six-stage model has little usefulness both for understanding changes over time and for treatment recommendations
Who said ‘Relapse is the rule rather than the exception’
Di Clemente et al. (2004)
What did DiClemente et al state about relapse
‘Relapse is the rule rather than the exception’
Does Prochaska’s six-stage model still take relapse seriously
Why / how is this shown in the model
Yes it is seen as more than just as slop.
Does not underestimate its potential to blow change entirely off course.
This is shown by being able to jump back multiple steps
What term best describes the six-stage model in terms of acknowledging addiction may require several attempts
Why
It has face validity.
More acceptable as it’s realising about relapse
What is a limitation to Prochaska’s six-stage model
There is evidence cha;ending the model
Who conducted a review of NICE and Prochaska’s six-stage model
David Taylor et al. (2006)
What was Taylors method when challenging the six-stage model
Analysed 24 reviews and meta-analyses of the six-stage model
What 2 things did Taylors conclude after his meta-analysis on Prochaska’s six-stage model
- The model was no more effective than appropriate alternatives (TPB) in changing nicotine addiction-related behaviours.
- The key concept of defined stages in behaviour change could not be validated by Avaliable data.
What type of change is Prochaska’s six-stage model of
Model of behaviour change
How can it be argued that Prochaska’s six-stage model is not of behaviour change
Clients can move between stages and can go backwards regardless of whether their behaviour changes or not
How is it argued that Prochaska’s six-stage model is of behaviour change
It emphasises that change unfolds over time and depends on whether someone is ready to change.
